5 Questions with Edgar Chedrawy, MD, MSc, MHA, FRCSC, FACS, CPE

An AAPL member since 2011, Edgar Chedrawy describes peri-operative care as “a journey” that begins with physician leaders inspiring and motivating their teams of caregivers at all phases — pre-, intra-, and post- operative — to learn and function at higher and coordinated levels. How is that achieved? “Through the leader’s own behavior,” says Chedrawy, “[when they] create an environment of psychological safety, communication, and innovation to improve healthcare delivery.” Chedrawy explains how that translates to improved clinical results and financial gains.

Q In 2012, you investigated for your MHA capstone thesis the effects of organized interprofessional collaboration on patients’ average length of stay. What did you learn?

A We learned that Collaborative Care Rounds — an organized and structured approach to post-operative care based on interprofessional collaboration of physicians, nurses, pharmacists, discharge planners, and social workers — not only reduced complications, but also shortened length of stay in a Chicago community teaching hospital. In our first year, average length of stay for 1,695 patients was reduced by 1.5 days — from 6.6 to 5.1 days.

Q What were the cost benefits associated with this inter- professional collaboration on length of stay?

A Detailed financial analysis showed an initial cost to the program of $856,000 for team training and salary support and a payback period of 1.58 years with a return on investment of 280 percent over a five-year period.

Q You’ve also written about the effects of Enhanced Recovery After Cardiac Surgery (ERACS) on readmission rates. What are the cost savings for ERACS versus non-ERACS groups?

A ERACS is a natural progression from Collaborative Care Rounds. ERACS focuses on the total journey with pre- operative optimization of patient, intra-operative and post-operative strategies focused on rapid recovery and early discharge. The benefit is not only in cost savings from a reduced length of stay, but also in improved patient experience. Our study protocol is ongoing at QEII Health Sciences Center in Halifax.

Q A 2017 JAMA report says the benefits of ERACS include significant reductions of post-op complications, length of stay, readmissions, and costs. For non-ERACS hospitals, how are initiatives that urge shorter stays reconciled with an HCAHPS-driven goal for fewer readmissions?

A Shorter length of stay does not necessarily mean higher readmissions. HCAHPS measures patients’ perceptions of their hospital experience with a focus on provider communication and planning for transitions of care. ERACS, we hope, will reduce length of stay, improve patient experience, and enhance patient engagement in the discharge process with the ultimate goal of reducing readmission.

Q Do you believe money-driven readmission goals in any way endanger patient health and safety?

A The Institute for Healthcare Improvement “Triple Aim” is to optimize the health system to simultaneously pursue three dimensions: improve patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per-capita cost of healthcare. One of these dimensions should not be at the expense of the other. Physician leadership can contribute to proper healthcare team design and collaboration leading to innovative healthcare delivery systems that can achieve these outcomes simultaneously.